The Vermont Statutes Online

Title 18: Health

Chapter 219: Health Information Technology and Telehealth

• Subchapter 001: HEALTH INFORMATION TECHNOLOGY

• § 9351. Health Information Technology Plan

  (a)(1) The Department of Vermont Health Access, in consultation with the Department’s Health Information Exchange Steering Committee, shall be responsible for the overall coordination of Vermont’s statewide Health Information Technology Plan. The Plan shall be revised annually and updated comprehensively every five years to provide a strategic vision for clinical health information technology.

  (2) The Department shall submit the proposed Plan to the Green Mountain Care Board annually on or before November 1. The Green Mountain Care Board shall approve, reject, or request modifications to the Plan within 45 days following its submission; if the Board has taken no action after 45 days, the Plan shall be deemed to have been approved.

  (3)(A) The Department, in consultation with the Steering Committee, shall administer the Plan.

  (B) The Plan shall include the implementation of an integrated electronic health information infrastructure for the sharing of electronic health information among health care facilities, health care professionals, public and private payers, and patients. The Plan shall provide for each patient’s electronic health information that is contained in the Vermont Health Information Exchange to be accessible to health care facilities, health care professionals, and public and private payers to the extent permitted under federal law unless the patient has affirmatively elected not to have the patient’s electronic health information shared in that manner.

  (C) The Plan shall include standards and protocols designed to promote patient education, patient privacy, physician best practices, electronic connectivity to health care data, access to advance care planning documents, and, overall, a more efficient and less costly means of delivering quality health care in Vermont.

  (b) The Health Information Technology Plan shall:

  (1) support the effective, efficient, statewide use of electronic health information in patient care, health care policymaking, clinical research, health care financing, and continuous quality improvements;

  (2) educate the general public and health care professionals about the value of an electronic health infrastructure for improving patient care;

  (3) ensure the use of national standards for the development of an interoperable system, which shall include provisions relating to security, privacy, data content, structures and format, vocabulary, and transmission protocols;

  (4) propose strategic investments in equipment and other infrastructure elements that will facilitate the ongoing development of a statewide infrastructure;

  (5) recommend funding mechanisms for the ongoing development and maintenance costs of a statewide health information system, including funding options and an implementation strategy for a loan and grant program;

  (6) incorporate the existing health care information technology initiatives to the extent feasible in order to avoid incompatible systems and duplicative efforts;

  (7) integrate the information technology components of the Blueprint for Health established in chapter 13 of this title, the Agency of Human Services’ Enterprise Master Patient Index and all other Medicaid management information systems being developed by the Department of Vermont Health Access, information technology components of the quality assurance system, the program to capitalize with loans and grants electronic medical record systems in primary care practices, and any other information technology initiatives coordinated pursuant to 3 V.S.A. § 3027; and

  (8) address issues related to data ownership, governance, and confidentiality and security of patient information.

  (c) The Department of Vermont Health Access, in consultation with the Steering Committee and subject to Green Mountain Care Board approval, may propose updates to the Plan in addition to the annual updates as needed to reflect emerging technologies, the State’s changing needs, and such other areas as the Department deems appropriate. The Department shall solicit recommendations from interested stakeholders in order to propose updates to the Health Information Technology Plan pursuant to subsection (a) of this section and to this subsection, including applicable standards, protocols, and pilot programs, and following approval of the proposed updates by the Green Mountain Care Board, may enter into a contract or grant agreement with appropriate entities to update some or all of the Plan. Upon approval of the updated Plan by the Green Mountain Care Board, the Department of Vermont Health Access shall distribute the updated Plan to the Secretary of Administration; the Secretary of Digital Services; the Commissioner of Financial Regulation; the Secretary of Human Services; the Commissioner of Health; the Commissioner of Mental Health; the Commissioner of Disabilities, Aging, and Independent Living; the Senate Committee on Health and Welfare; the House Committee on Health Care; affected parties; and interested stakeholders. Unless major modifications are required, the Department may present updated information about the Plan to the legislative committees of jurisdiction in lieu of creating a written report.

  (d) The Health Information Technology Plan shall serve as the framework within which the Green Mountain Care Board reviews certificate of need applications for information technology under section 9440b of this title. In addition, the Commissioner of Information and Innovation shall use the Health Information Technology Plan as the basis for independent review of State information technology procurements.

  (e) The privacy standards and protocols developed in the Statewide Health Information Technology Plan shall be no less stringent than applicable federal and State guidelines, including the “Standards for Privacy of Individually Identifiable Health Information” established under the Health Insurance Portability and Accountability Act of 1996 and contained in 45 C.F.R., Parts 160 and 164, and any subsequent amendments, and the privacy provisions established under Subtitle D of Title XIII of Division A of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, § 13400 et seq. The standards and protocols shall require that access to individually identifiable health information is secure and traceable by an electronic audit trail.

  (f) [Repealed.] (Added 2009, No. 61, § 1; amended 2009, No. 156 (Adj. Sess.), § I.25; 2011, No. 63, § G.103; 2013, No. 79, § 49b; 2015, No. 172 (Adj. Sess.), § E.306; 2017, No. 85, § F.9, eff. June 28, 2017; 2017, No. 187 (Adj. Sess.), § 2, eff. May 28, 2018; 2019, No. 53, § 4, eff. March 1, 2020.)

• § 9352. Vermont Information Technology Leaders

  (a) Governance. The Vermont Information Technology Leaders, Inc. (VITL) Board of Directors shall consist of no fewer than nine nor more than 14 members. The term of each member shall be two years, except that of the members first appointed, approximately one-half shall serve a term of one year and approximately one-half shall serve a term of two years, and members shall continue to hold office until their successors have been duly appointed. The Board of Directors shall comprise representatives of the business community, of health care consumers, of Vermont hospitals, of Vermont-licensed clinicians, and of health insurers licensed to offer plans in Vermont, as well as individuals familiar with health information technology, including, to the extent practicable, one or more individuals who are or have served as the chief technology officer for a health care facility.

  (b) Conflict of interest. In carrying out their responsibilities under this section, Directors of VITL shall be subject to conflict of interest policies established by the Secretary of Administration to ensure that deliberations and decisions are fair and equitable.

  (c) Health information exchange operation.

  (1) VITL shall be designated in the Health Information Technology Plan approved by the Green Mountain Care Board pursuant to section 9351 of this title to operate the exclusive statewide health information exchange network for this State. The Plan shall determine the manner in which Vermont’s health information exchange network shall be managed. The Green Mountain Care Board shall have the authority to approve VITL’s budget pursuant to chapter 220 of this title. Nothing in this chapter shall impede local community providers from the exchange of electronic medical data.

  (2) Notwithstanding any provision of 3 V.S.A. § 2222 or 2283b to the contrary, upon request of the Secretary of Administration, the Agency of Digital Services shall review VITL’s technology for security, privacy, and interoperability with State government information technology, consistent with the State’s health information technology plan required by section 9351 of this title.

  (d) Privacy. The standards and protocols implemented by VITL shall be consistent with those adopted by the statewide Health Information Technology Plan pursuant to subsection 9351(e) of this title.

  (e) Report. On or before January 15 of each year, VITL shall file a report with the Green Mountain Care Board; the Secretary of Administration; the Secretary of Digital Services; the Commissioner of Financial Regulation; the Commissioner of Vermont Health Access; the Secretary of Human Services; the Commissioner of Health; the Commissioner of Mental Health; the Commissioner of Disabilities, Aging, and Independent Living; the Senate Committee on Health and Welfare; and the House Committee on Health Care. The report shall include an assessment of progress in implementing health information technology in Vermont and recommendations for additional funding and legislation required. In addition, VITL shall publish minutes of VITL meetings and any other relevant information on a public website. The provisions of 2 V.S.A. § 20(d) (expiration of required reports) shall not apply to the report to be made under this subsection.

  (f) Funding authorization. VITL is authorized to seek matching funds to assist with carrying out the purposes of this section. In addition, it may accept any and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof, and from any person, firm, foundation, or corporation for any of its purposes and functions under this section and may receive and use the same, subject to the terms, conditions, and regulations governing such donations, gifts, and grants. VITL shall not use any State funds for health care consumer advertising, marketing, or similar services unless necessary to comply with the terms of a contract or grant that requires a contribution of State funds.

  (g) Waivers. The Secretary of Human Services or designee, in consultation with VITL, may seek any waivers of federal law, of rule, or of regulation that might assist with implementation of this section.

  (h) [Repealed.]

  (i) Certification of meaningful use and connectivity.

  (1) To the extent necessary to support Vermont’s health care reform goals or as required by federal law, VITL shall be authorized to certify the meaningful use of health information technology and electronic health records by health care providers licensed in Vermont.

  (2) VITL, in consultation with health care providers and health care facilities, shall establish criteria for creating or maintaining connectivity to the State’s health information exchange network. VITL shall provide the criteria annually on or before March 1 to the Green Mountain Care Board established pursuant to chapter 220 of this title.

  (j) Scope of activities. VITL and any person who serves as a member, director, officer, or employee of VITL with or without compensation shall not be considered a health care provider as defined in subdivision 9432 of this title for purposes of any action taken in good faith pursuant to or in reliance upon provisions of this section relating to VITL’s:

  (1) governance;

  (2) electronic exchange of health information and operation of the statewide Health Information Exchange Network as long as nothing in such exchange or operation constitutes the practice of medicine pursuant to 26 V.S.A. chapter 23 or 33;

  (3) implementation of privacy provisions;

  (4) funding authority;

  (5) application for waivers of federal law;

  (6) establishment and operation of a financing program providing electronic health records systems to providers; or

  (7) certification of health care providers’ meaningful use of health information technology. (Added 2009, No. 61, § 1; amended 2009, No. 67 (Adj. Sess.), § 108; 2009, No. 156 (Adj. Sess.), § I.26; 2011, No. 63, § G.104; 2013, No. 79, § 34a, eff. June 7, 2013; 2013, No. 142 (Adj. Sess.), § 34; 2015, No. 54, § 9, eff. June 5, 2015; 2015, No. 172 (Adj. Sess.), § E.306.1; 2017, No. 187 (Adj. Sess.), § 3, eff. May 28, 2018; 2023, No. 6, § 223, eff. July 1, 2023.)

• Subchapter 002: TELEHEALTH

• § 9361. Health care providers delivering health care services through telemedicine or by store-and-forward means

  (a) As used in this section, “distant site,” “health care provider,” “originating site,” “store and forward,” and “telemedicine” shall have the same meanings as in 8 V.S.A. § 4100k.

  (b) Subject to the limitations of the license under which the individual is practicing, a health care provider licensed in this State may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

  (c)(1) A health care provider delivering health care services or dental services through telemedicine shall obtain and document a patient’s oral or written informed consent for the use of telemedicine technology prior to delivering services to the patient.

  (A) The informed consent for telemedicine services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telemedicine within the provider’s profession and shall include, in language that patients can easily understand:

  (i) an explanation of the opportunities and limitations of delivering health care services or dental services through telemedicine;

  (ii) informing the patient of the presence of any other individual who will be participating in or observing the patient’s consultation with the provider at the distant site and obtaining the patient’s permission for the participation or observation; and

  (iii) assurance that all services the health care provider delivers to the patient through telemedicine will be delivered over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

  (B) For services delivered through telemedicine on an ongoing basis, the health care provider shall be required to obtain consent only at the first episode of care.

  (2) The provider shall include the patient’s written consent in the patient’s medical record or document the patient’s oral consent in the patient’s medical record.

  (3) A health care provider delivering telemedicine services through a contract with a third-party vendor shall comply with the provisions of this subsection (c) to the extent permissible under the terms of the contract. If the contract requires the health care provider to use the vendor’s own informed consent provisions instead of those set forth in this subsection, the health care provider shall be deemed to be in compliance with the requirements of this subsection if he or she adheres to the terms of the vendor’s informed consent policies.

  (4) Notwithstanding any provision of this subsection to the contrary, a health care provider shall not be required to obtain a patient’s informed consent for the use of telemedicine in the following circumstances:

  (A) in the case of a medical emergency;

  (B) for the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or

  (C) for a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3).

  (d) Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telemedicine consultation with a patient.

  (e)(1) A patient receiving health care services or dental services by store-and-forward means shall be informed of the patient’s right to refuse to receive services in this manner and to request services in an alternative format, such as through real-time telemedicine services or an in-person visit.

  (2) Receipt of services by store-and-forward means shall not preclude a patient from receiving real-time telemedicine services or an in-person visit with the distant site health care provider at a future date.

  (3) Originating site health care providers involved in the store-and-forward process shall obtain informed consent from the patient as described in subsection (c) of this section. (Added 2011, No. 107 (Adj. Sess.), § 4, eff. May 8, 2012; amended 2017, No. 64, § 2, eff. Oct. 1, 2017; 2019, No. 91 (Adj. Sess.), § 25, eff. March 30, 2020.)

• § 9362. Health care providers delivering health care services by audio-only telephone

  (a) As used in this section, “health insurance plan” and “health care provider” have the same meaning as in 8 V.S.A. § 4100l and “telemedicine” has the same meaning as in 8 V.S.A. § 4100k.

  (b)(1) Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the provider’s licensing board on the appropriate use of audio-only telephone in health care delivery.

  (2) A health care provider delivering health care services using audio-only telephone shall include or document in the patient’s medical record:

  (A) the patient’s informed consent for receiving services using audio-only telephone in accordance with subsection (c) of this section; and

  (B) the reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio-only telephone.

  (3)(A) A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner.

  (B) A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone.

  (c) A health care provider delivering health care services by audio-only telephone shall obtain and document a patient’s oral or written informed consent for the use of audio-only telephone prior to the appointment or at the start of the appointment but prior to delivering any billable service.

  (1) The informed consent for audio-only telephone services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telephone services within the provider’s profession and shall include, in language that patients can easily understand:

  (A) that the patient is entitled to choose to receive services by audio-only telephone, in person, or through telemedicine, to the extent clinically appropriate;

  (B) that receiving services by audio-only telephone does not preclude the patient from receiving services in person or through telemedicine at a later date;

  (C) an explanation of the opportunities and limitations of delivering and receiving health care services using audio-only telephone;

  (D) informing the patient of the presence of any other individual who will be participating in or listening to the patient’s consultation with the provider and obtaining the patient’s permission for the participation or observation;

  (E) whether the services will be billed to the patient’s health insurance plan if delivered by audio-only telephone and what this may mean for the patient’s financial responsibility for co-payments, coinsurance, and deductibles; and

  (F) informing the patient that not all audio-only health care services are covered by all health plans.

  (2) For services delivered by audio-only telephone on an ongoing basis, the health care provider shall be required to obtain consent only at the first episode of care.

  (3) If the patient provides oral informed consent, the provider shall offer to provide the patient with a written copy of the informed consent.

  (4) Notwithstanding any provision of this subsection to the contrary, a health care provider shall not be required to obtain a patient’s informed consent for the use of audio-only telephone services in the case of a medical emergency.

  (5) A health care provider may use a single informed consent form to address all telehealth modalities, including telemedicine, store and forward, and audio-only telephone, as long as the form complies with the provisions of section 9361 of this chapter and this section.

  (d) Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telephone consultation with a patient.

  (e) Audio-only telephone services shall not be used in the following circumstances:

  (1) for the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or

  (2) for a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3). (Added 2021, No. 6, § 5, eff. March 29, 2021.)